title: Are traditional NSAIDs prescribed appropriately among French elderly with osteoarthritis? Results from the CADEUS cohort.
abstract: OBJECTIVE
  To describe the inappropriate use of traditional non-steroidal anti-inflammatory drugs (tNSAIDs) in elderly subjects in the CADEUS cohort using the Beers 2003 criteria modified by recommendations from the French Medicines Agency.
  
  
  METHODS
  Of the 23,217 subjects in the CADEUS cohort, 1,851 were ≥65 years old, had bee diagnosed with osteoarthritis (OA), and had been dispensed a tNSAID at least once in the 6 months before the index date. Data were obtained from the French national reimbursement database and from patient and prescriber questionnaires. The Beers criteria for inappropriate use were modified to include all tNSAIDs, and long-term high-dose use was defined as having been dispensed at least five dispensations for tNSAID over a 6-month period with a gap of <45 days between each dispensation and when the gap was >45 days, medicine availability >50% [i.e., defined daily dose (DDD) delivered/theoretical DDD] for the gap.
  
  
  RESULTS
  The most frequently dispensed tNSAIDs were piroxicam (25%), diclofenac (24%), ibuprofen (18%), ketoprofen (18%), and naproxen (10%). Of the study population, 1.5% were dispensed indomethacin; 15%, two tNSAIDs; 15%, a tNSAIDs with a platelet aggregation inhibitor; 4.6%, a tNSAID with low-dose aspirin; 0.2%, a tNSAID with vitamin K antagonists. The analysis revealed that 18% of the study population were high-dose and long-term users of tNSAIDs and that 70% of these were dispensed a proton pump inhibitor.
  
  
  CONCLUSIONS
  The most common inappropriate tNSAID dispensation was the co-prescription of two different tNSAIDs within 1 month or of a platelet aggregation inhibitor. The real-life consequences of our results need to be ascertained, and it would be interesting to update the Beers criteria.
authors.affiliation: INSERM CIC-P 0005 Pharmaco-Epidémiologie, Service de Pharmacologie, Université Bordeaux Segalen-CHU de Bordeaux, Bâtiment le Tondu-Case 41, 146, Rue Léo Saignat, 33076, Bordeaux Cedex, France.
authors.forename: Sinem Ezgi
authors.initials: SE
authors.lastname: Gulmez
authors.forename: Cécile
authors.initials: C
authors.lastname: Droz-Perroteau
authors.forename: Régis
authors.initials: R
authors.lastname: Lassalle
authors.forename: Patrick
authors.initials: P
authors.lastname: Blin
authors.forename: Bernard
authors.initials: B
authors.lastname: Bégaud
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Annie
authors.initials: A
authors.lastname: Fourrier-Réglat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing; D007349:Insurance, Health, Reimbursement; D008297:Male; D009313:National Health Programs; D010003:Osteoarthritis / Q000188:drug therapy*; D010894:Piroxicam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D010894:Piroxicam; D004008:Diclofenac